HUD-91186-1 Multifamily Housing Service Coordinator First-Time Fundi

Multifamily Housing Service Coordinator
First-Time Funding Request

OMB Approval Number 2502-0447
(exp. 01/31/2007)

The public reporting burden for this collection of information for the Multifamily Housing Service Coordinator Programs is estimated to average 11 hours per response for applicants, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. HUD may not conduct, and a person is not required to respond to, a collection of information unless the collection displays a valid control number. HUD collects the
information under Section 671 of the Housing and Community Development Act of 1992, and uses the information to determine an applicant's need for and capacity to administer grant funds. The information submitted is subject to the disclosure requirements of the
Department of Housing and Urban Development Reform Act of 1989 (42 U.S.C. 3545). Providing this information is required to obtain benefits.

Name and Address of Applicant/Owner:

1. Project Information: Please provide the information for every project included in your request; add more rows if needed.
c. FHA or Project d. Section 8 Number e. # of Subsidized
b. Project Type (I.e. Sec. 202, 236,
a. Project Name and Address
Number
221(d)(3)BMIR, or Sec. 8)
Rental Units

f. Resident Information
Estimate # of Frail Elderly
Estimate # of at Risk Elderly
Estimate # Non-Elderly People w/ Disabilities
Remaining Residents

Number of Residents % of Total Residents
______
______
0% %
______
______
0% %
______
______
0% %
0% %
______
______

g. If the SC will serve multiple eligible projects, give
proportionate amount of time planned for each site.
Project Name(s)
# of Hours per week

0
Total
100%
h. Is there an SC currently working at this project? ______ Yes ______ No
If yes: 1. How many hours per week does the Service Coordinator
2. How many hours per week do you want 3. Will you extend current employees
currently work?
to add to your program?
hours or hire additional staff?
2. Budget Information**
a. Personnel (Direct Labor/Salary)
Identify Position - SC or Aide

Hours

Rate per Hour

Year1

Year 2

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total Direct Labor Cost

Page 1 of 1

Year 3

0.00

Tot 3-Year

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Form HUD-91186
(1/3/2007)

b. Fringe Benefits

Rate (%)

Base

Year1

0.00%
0%
0%
0%
0%
0%
Total Fringe Benefits Cost
c. Quality Assurance/Program Evaluation
(cap - 10% of line "a", Personnel)

Hours

Rate Per Hour

Year1

Hours

Rate Per Hour

e. Travel (Indicate local private vehicle, (mileage and rate per mile) airfare (trips and fare),
other (quantity and unit cost), per diem (days and rate per day).

Total Travel
Unit Cost

Year 1

Total Supplies and Materials

Page 2 of 8

Year 3

Year 2

0.00
0.00
0.00
0.00
0.00
0.00

0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
Tot 3-Year

0.00

0.00
0.00
0.00
0.00
0.00
0.00
Tot 3-Year

Year 3

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
Tot 3-Year

Year 3

Year 2

0.00
Quantity

0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
Tot 3-Year

Year 3

Year 2

Year 1

0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total Training

f. Supplies and Materials

Year 2

Year 1

Tot 3-Year

Year 3

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total Quality Assurance
d. Training

Year 2

0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00

Form HUD-91186
(1/3/2007)

g. Start-up Costs
1. Creating Private Office Space

Subtotal for Private Office Space
2. Office Furniture/Equipment

Quantity

Unit Cost

Year 1

Quantity

Unit Cost

Year 1

Quantity

Unit Cost

Year 2

Year 1

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Tot 3-Year

Year 3

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Year 2

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total Other Direct Costs
Subtotal of Direct Costs
I. Indirect Costs

Tot 3-Year

Year 3

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Subtotal Cost of Furniture/Equipment
Total Start-Up Costs
h. Other Direct Costs

Year 2

0.00
0.00
0.00
0.00
0.00
0.00
0.00

Quantity

Unit Cost

Year 1

Total Indirect Costs
j. Total Estimated Costs

0.00
0.00
Year 2

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Tot 3-Year

Year 3

0.00
0.00

Tot 3-Year

Year 3

0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

** Please note: You may increase costs from year to year by no more than 3%.

Page 3 of 8

Form HUD-91186
(1/3/2007)

k. Contracts: If you plan to contract out for a Service Coordinator or for Quality Assurance, list related cost. Give item and related cost.

l. Quality Assurance is _______% of line a, "Personnel (Direct Labor)". (Cannot exceed 10%.)
3. Funding Sources and Time Periods (Indicate all that apply.)

Grant

$ Amount

# of Years

# of Months

Section 8 Operating Funds
(i.e. Budget-based)

$ Amount

# of Years

# of Months

From Date

To Date

Residual Receipts

$ Amount

# of Years

______
# of Months
From Date

To Date

# of Years

______
# of Months
From Date

To Date

Excess Income

$ Amount

Signature: __________________________________________

Contact Name: _________________________

Date: _______________

Phone #: ____________________

Page 4 of 8

Email: _______________________________

Form HUD-91186
(1/3/2007)

Project Information: Please provide the information for every project included in your request; add more rows if needed.
c. FHA or Project d. Section 8 Number e. # of Subsidized
2. a. Project Name and Address
b. Project Type (I.e. Sec. 202, 236,
Number
Rental Units
221(d)(3)BMIR, or Sec. 8)

f. Resident Information
Estimate # of Frail Elderly
Estimate # of at Risk Elderly
Estimate # Non-Elderly People w/ Disabilities
Remaining Residents

Number of Residents % of Total Residents
0%
______
______
0%
______
______
0%
______
______
0%
______
______

g. If the SC will serve multiple eligible projects, give
proportionate amount of time planned for each site.
Project Name(s)
# of Hours per week

0
Total
100%
h. Is there an SC currently working at this project? ______ Yes ______ No
2. How many hours per week do you want 3. Will you extend current employees
If yes: 1. How many hours per week does the Service Coordinator
to add to your program?
hours or hire additional staff?
currently work?

Project Information:

3. a. Project Name and Address

f. Resident Information
Estimate # of Frail Elderly
Estimate # of at Risk Elderly
Estimate # Non-Elderly People w/ Disabilities
Remaining Residents
Total

b. Project Type (I.e. Sec. 202, 236,
221(d)(3)BMIR, or Sec. 8)

Number of Residents % of Total Residents
0%
______
______
0%
______
______
0%
______
______
0%
______
______

0

c. FHA or Project d. Section 8 Number e. # of Subsidized
Number
Rental Units

g. If the SC will serve multiple eligible projects, give
proportionate amount of time planned for each site.
Project Name(s)
# of Hours per week

100%

Page 5 of 8

More Projs Form HUD-91186

(1/3/2007)

h. Is there an SC currently working at this project? ______ Yes ______ No
If yes: 1. How many hours per week does the Service Coordinator
2. How many hours per week do you want 3. Will you extend current employees
hours or hire additional staff?
currently work?
to add to your program?

Project Information:

4. a. Project Name and Address

f. Resident Information
Estimate # of Frail Elderly
Estimate # of at Risk Elderly
Estimate # Non-Elderly People w/ Disabilities
Remaining Residents

b. Project Type (I.e. Sec. 202, 236,
221(d)(3)BMIR, or Sec. 8)

Number of Residents % of Total Residents
0%
______
______
%
0%
______
______
%
0%
______
______
%
0%
______
______
%

c. FHA or Project d. Section 8 Number e. # of Subsidized
Number
Rental Units

g. If the SC will serve multiple eligible projects, give
proportionate amount of time planned for each site.
Project Name(s)
# of Hours per week

0.00
100%
Total
h. Is there an SC currently working at this project? ______ Yes ______ No
If yes: 1. How many hours per week does the Service Coordinator
2. How many hours per week do you want 3. Will you extend current employees
currently work?
to add to your program?
hours or hire additional staff?

Project Information:

5. a. Project Name and Address

Estimate # of Frail Elderly
Estimate # of at Risk Elderly
Estimate # Non-Elderly People w/ Disabilities
Remaining Residents

b. Project Type (I.e. Sec. 202, 236,
221(d)(3)BMIR, or Sec. 8)

Number of Residents % of Total Residents
0%
______
______
%
0%
______
______
%
0%
______
______
%
0%
______
______
%

c. FHA or Project d. Section 8 Number e. # of Subsidized
Number
Rental Units

g. If the SC will serve multiple eligible projects, give
proportionate amount of time planned for each site.
Project Name(s)
# of Hours per week

0.00
100%
Total
h. Is there an SC currently working at this project? ______ Yes ______ No
If yes: 1. How many hours per week does the Service Coordinator
2. How many hours per week do you want 3. Will you extend current employees
currently work?
to add to your program?
hours or hire additional staff?

Page 6 of 8

More Projs Form HUD-91186

(1/3/2007)

Instructions for completing the HUD-91186
Section 2: Budget Information
a. Personnel (Direct Labor)

b. Fringe Benefits

c. Quality Assurance

d. Training
e. Travel

f. Supplies and Materials

g.1. Creating Private Office
Space
g.2. Office Furniture and
Equipment
Total Start-Up Costs
h. Other Direct Costs

i. Indirect Costs

j. Grand Total

k. Contracts (Sub-Grantees)

This section should show the labor costs for The Service Coordinators and/or
aides. Use the hourly labor cost for salaried employees (use 2080 hours per
year or the value your organization uses to perform this calculation). You may
include payroll taxes here. Do not show fringe or other indirect costs in this
section.
Use the same standard fringe rate used by your organization. You may use a
single fringe rate (a percentage of the total direct labor) or list each of the
individual fringe charges. Use the Total Direct Labor Cost as the base for the
fringe calculation. If your organization calculates fringe benefits differently, use
a different base and discuss how you calculate fringe as a comment.
Give the title of the professional (e.g. MSW) or agency who will be performing
QA, the number of hours over the year you expect to use them, and their
hourly rate. Quality Assurance is limited to program evaluation activities and
cannot exceed 10% of line a, Personnel.
Give fees and rates for appropriate training programs, to the extent known.
Otherwise estimate and provide basis for the anticipated cost.
Provide mileage and cost estimates for use of private vehicles or public
transportation; show the estimated cost of airfare required to attend training
programs, and list necessary per diem rates in accordance with your
organization’s policies. Give travel destinations if known.
List the supplies you propose to purchase. You can use an anticipated
consumption rate to estimate the cost of office or other common supplies, (e.
g. 1 box paper clips every 3 months). Include replacement of office
equipment. List items individually along with the quantity and their anticipated
cost.
List expenses associated with setting up a private office for the Service
Coordinator. List each anticipated cost. You may incur These costs only
during the first year of your program.
List start-up expenses related to furniture, computers, printers, and other office
equipment. List the quantity and unit cost.
Sum of lines g.1 and g.2.
Include costs such as telephone and Internet Service, printing, postage, and
maintenance of office equipment, when such costs are attributable to the SC
program only.
OMB Circular A87 defines indirect costs as those that have been incurred by
multiple programs for common or joint purposes. Indirect costs are associated
with the centralized services distributed throughout your agency and cannot be
readily identified with one particular program. Additionally, the costs should
not be otherwise treated as direct costs. If your organization already has an
established indirect cost rate, use this rate and explain how it is calculated.
Sum lines “a” through “i” for each year. Then add the annual totals together to
get to the total 3-year amount. You may increase costs from year to year by
no more than 3%.
If you will contract with a public or private agency to provide the Service
Coordinator or Quality Assurance, list the activities and costs included in the
contract in this section.

Page 7 of 8

Instructions Form HUD-91186

(1/3/2007)

l. Quality Assurance Percent of Quality Assurance costs cannot exceed 10% of your total Personnel/Direct
line a, Personnel
labor cost. Calculate your percentage and include on this line, to ensure you
are within the 10% cap.
Section 3: Funding Sources and Time Periods
Housing owners can use any of the four funding sources to pay the costs of a Service Coordinator program.
You may use these resources individually or in combination with each other. Indicate which funding sources
you propose to use, by giving the dollar amount, the number of years and months during which you will use the
funds, and the dates of the time period, if known (e.g. from May 1, 2004 to April 30, 2005).

Page 8 of 8

Instructions Form HUD-91186

(1/3/2007)